Effective Dates: 04/21/2025 - Present Previous | Next

TN 3 (04-25)

DI 27540.035 Concurrent Title II/Title XVI – Statutory Benefit Continuation Does Not Apply

A. Policy

Goldberg/Kelly automatic payment continuation governs the following types of reopenings and revisions:

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    Failure to follow prescribed treatment; and

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    Fraud or similar fault.

For information on the cases where the Disability Determination Services (DDS) sends a predetermination due process notice, see Policy – Due Process for Adverse Reopenings DI 27525.001C.

See Also:

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    DI 27525.010 Providing Due Process in Adverse Reopenings Involving Title XVI and Concurrent Title II/Title XVI Cases.

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    DI 28075.005 Failure to Cooperate (FTC) During a Medical Continuing Disability Review (CDR)

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    DI 28075.007 Whereabouts Unknown (WU) During a Medical Continuing Disability Review (CDR

NOTE: Goldberg/Kelly procedures do not apply to Title XVI whereabouts unknown cases because WU (S06) is considered an administrative suspension and does not result in a loss of eligibility.

B. Reopening and revision is less than fully favorable

1. Allowance to closed period – Title II and Title XVI

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    Allowance to Closed Period – Title II – Reopening Notice 4 (NL 00705.216)

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    Allowance to Closed Period – Title XVI – Reopening Notice 5 (NL 00705.221)

2. Denial to partially favorable onset (not AOD) – Title II and Title XVI

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    Denial to Partially Favorable Onset (Not AOD) – Title II – Reopening Notice 6 (NL 00705.226)

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    Denial to Partially Favorable Onset (Not AOD) – Title XVI – Reopening Notice 7 (NL 00705.231)

3. Denial to closed period – Title II and Title XVI

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    Denial to Closed Period – Title II – Reopening Notice 8 (NL 00705.236)

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    Denial to Closed Period – Title XVI – Reopening Notice 9 (NL 00705.241)

4. Fully or partially favorable onset to a later onset

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    Fully Favorable or Partially Favorable Onset to a Later Onset – Title II – Reopening Notice 10 (NL 00705.246)

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    Fully Favorable or Partially Favorable Onset to a Later Onset – Title XVI – Reopening Notice 11 (NL 00705.251)

C. Reopening and revision is unfavorable

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    Allowance to Denial – Title II – Reopening Notice 1 (NL 00705.201)

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    Allowance to Denial – Title XVI – Reopening Notice 2 (NL 00705.206)

D. Basis change only – blind to disabled

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    Change in Basis – Blind to Disabled – Title II – Reopening Notice 13 (NL 00705.261)

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    Change in Basis – Blind to Disabled – Title XVI – Reopening Notice 14 (NL 00705.266)

E. No change in basis or end result – claimant aware or denial of request to reopen and revise

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    No Change in Basis or End Result – Claimant Aware or Denial of Request to Reopen – Title II – Reopening Notice 12 (NL 00705.256). Add disclaimer paragraph 842.

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    No Change in Basis or End Result – Claimant Aware or Denial of Request to Reopen – Title XVI – Reopening Notice 12 (NL 00705.256). Add disclaimer paragraph 841.

F. No change in basis or end result-claimant unaware

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    Title II – No DDS notice is required.

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    Title XVI – No DDS notice is required.

G. Reopening and revision is unfavorable – Notifying auxiliaries in separate households

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    Auxiliary – Title II – Reopening Notice 3 (NL 00705.211)

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    Title XVI – no DDS notice is required.

To Link to this section - Use this URL:
http://policy.ssa.gov/poms.nsf/lnx/0427540035
DI 27540.035 - Concurrent Title II/Title XVI – Statutory Benefit Continuation Does Not Apply - 04/21/2025
Batch run: 04/21/2025
Rev:04/21/2025